C.A.R.E. Knowledge Blog

Missed Appointments with Your Care Provider

 

I thought this video update from CROI was worth re-posting here. The data that they talked about has to do with the relationship between missed clinical appointments and health outcomes. What was interesting is that the study was done by Kaiser-Permanente, so the population with HIV had health care. For patients who missed visits in the first year after their diagnosis, there was a two-fold increase in mortality. Missing a visit had a greater impact than having a CD4 count under 100. 

As we move into the era of "Test and Treat," we need to stay focused on everything necessary to keep people in care. What they refer to in the video as the treatment cascade is essentially this: 

Not everyone who tests positive gets enrolled in care, and of those enrolled, some aren't getting lab work done. In the old guidelines for treatment, providers often waited until CD4 counts dropped, so some weren't eligible for anti-retroviral therapy. Another barrier not shown is that doctors are often reluctant to offer HIV medications to people who are dealing with untreated mental health issues, housing problems, and illegal drug use. Then there are issues around people sticking to their regimen through the fist bumpy weeks of immune reconstitution and short-term side effects. Then there are the issues that can arise in anyone's life--loosing a job or health insurance, personal problems, and more that can play havoc with adherence. We'll need to look at all these issues, identify barriers, and find ways to overcome them if we expect the pills to do their work.

 

Silence = Stigma

Stigma has been a big issue in the support groups here at CARE. Or rather, self-stigmatizing has kept people from attending the group. 

For most of the people attending the newly diagnosed group, they've been meeting people in a social arena that uses avoidance of people who are positive who disclose their status. Terms like "clean" and "disease-free" are put out with the hope that by avoiding people who know they are postive, they will avoid the virus. One result of this is that they seldom have any friends who are positive and out about their status--plantonic or otherwise. 

Unfortunately, the main drivers of the epidemic are people who don't know that they're positive. Often someone tests negative, and even after a few more encounters, they're still posting that they tested negative two, four, or six months ago. And as far as they know, they are negative--based on their last test result. 

So when the viral apartheid strategy fails, they're sequestered in an HIV closet of sorts. 

If disclosure is to be the norm, more positive people will need to be open about their status, negative people will need to be more accepting of their positive brothers, sisters, lovers, and friends, and public health messages will need to adress these important issues. 

Dirty Pools

Among my duties here at the CARE Program I also do the HIV testing. CARE offers free rapid testing for HIV using an oral swab, with results in twenty minutes. 

As part of the testing process I fill out a risk assessment form with the client. By the time the client leaves my office, they should have a pretty good idea of their own risk of aquiring HIV. The questions fall into two categories--those that address the mechanics of transmission--like sharing needles, or what body part is going in what orafice. The other questions assess risk in terms of risk groups. 

Everyone is a individual, but some groups have higher numbers of people living with HIV. In public health, this is called prevalence. If you have sex with someone in a high-risk group, you're more likely to be having sex with someone who is positive. 

By far the group with the highest prevalence is gay men. In Long Beach, like most urban areas, HIV prevalence among gay men is as high as one in four or one in five. Other high-risk groups include sex workers, people who inject drugs, transgenders, and men who have been incarcerated. 

It's good to protect yourself by using condoms--or clean needles if you inject, and it's also good to be aware of the amount of HIV in the "pool" of people you're swimming with.

If you'd like to get tested for HIV, our office is located at 411 East 10th Street, Suite 107, Long Beach, CA 90813. To schedule an appointment, call (562) 624-4900. Testing hours and information are located here. 

Real Time Meet Up for Young Poz Folks 29 and Under: A New Long Beach Support Group

R7+s 

That's l33t, or "leetspeak" for Real Time Positives, a new support group for HIV-positive folks 29 and under. The group starts October 12, and will meet every Wednesday at 5:30pm at the Parr Center on the 2nd floor. The Parr Health Enhancement Center is located next to the parking structure on the St. Mary Medical Center campus.

Dealing with and HIV diagnosis when you're young can feel like taking two steps backwards for every step forward. You may be in shcool, starting down a new career path, or trying to get established on your own two feet. Now you have to add medical visits and pills to the mix of dating, meeting new people, having a social life, and trying to be more independent. 

There will be food and drink, plus other young people dealing with and HIV or AIDS diagnosis. Some may be a little further along and others are just finding out. Gain some insight, share what you know, and make new friends.

For more information, call (562) 624-4977 or email.

We've also updated the CARE Program page for support groups, with listings for support groups for the newly diagnosed, those in recovery, dealing with a hepatitis C co-infection, and more. 

Black Gay Men and HIV in Long Beach

Last week I blogged about the CDC's report on the stable number of new infections; buried in the report's subtitle was the growing numbers of new HIV cases among Black gay men. Frank Oldham, preseident of the NAPWA (National Association of People with AIDS) has sent out an open letter, which is worth quoting at length here.

NAPWA and I personally salute the CDC for reporting Wednesday what we all already guessed: the number of new HIV infections is level for the country as a whole but is steadily rising in young gay Black men. Tom Frieden spoke for all of us when he said, "We're very concerned about this trend." As an openly gay Black man who has lived with HIV for twenty-two years and seen friends and partners die, I wholeheartedly agree: we have to change this.

Studies show that young gay Black men are at least as likely to use condoms as their non-Black peers, so we cannot blame the rapid spread of HIV among them on riskier behavior. On the contrary: it is driven by the high number of young gay Black men already infected and the high number of them who do not know they are infected. The special impact of HIV on these young people is caused by structural issues in American society that mainstream politicians and press don't like to talk about - especially in this Tea Party-driven political climate.

Structural issues are always hard to talk about. Poverty and prejudice are harder than any. But let's face facts: HIV's disproportionate impact on African-Americans and other Americans of color is the price this country pays for letting color mean poverty, and poverty mean substandard healthcare and health literacy. And HIV's disproportionate impact on young gay men has everything to do with stigma and homophobia, which discourage young men from learning their status and seeking treatment. Let those two problems come together and you have the perfect storm.

We need to address unequal economic and educational opportunity, which keep poor people poor, but that will be a generation's work. In the mean time, all lower-income Americans, White and Black, straight and gay, need fairer access to healthcare and support services. Achieving that, in this political climate,  means driving home relentlessly the objective truth that three-quarters of HIV-related healthcare costs are borne in the public sector, and it costs the public less to test aggressively and treat early than to do nothing and let more people get sick. Our best defense in the coming deficit reduction negotiations is a good offense: it costs more to do less, and we can prove it.

Good figures on local HIV statistics are hard to come by. In Long Beach about 13% of the population is African American, yet they make up one quarter of new HIV cases. As Frank Oldham points out, drivers of the epidemic are not riskier behaviors, but riskier partners: if you're having sex with a segment of the population that is one quarter positive, the chances of being exposed are much higher. Compounding the problem is the number of people who have HIV but don't know it. Here in Long Beach, it's estimated to be 1500 people who are positive and have yet to find out. Because their HIV is not treated, levels of the virus are higher, making it easier for them to infect someone else. 

As Oldham states, it costs less to test agressively and treat early than to do nothing and let people get sick. Here at the CARE Program we offer free confidential HIV testing with results in 20 minutes. Call 562-624-4900 to scedule a test. 

New Support Group for HIVHep-C Co-Infected in Long Beach

The CARE Progam now has an education and support group for individuals co-infected with both hepatitis C and HIV. With the approval of new therapies, and a new co-infected HCV/HIV clinic at the CARE Program, now is an opportune time to look into treatment options, voice concerns, and hear from others who are contemplating hep-C treatment, or are on treatment and looking for support and information on ways to manage side effects, and those who have successfully completed their course of therapy. 

The group meet the 2nd and 4th Wednesday of the month from 1:30 to 3:15pm at the CARE Clinic, 1043 Elm Avenue, Suite 300, Long Beach, CA 90813. The group includes an education component along with peer discussion and support. 

For more information, contact Paul Lovely at 562-624-4963.